Impact of continuity of care on cardiovascular disease risk among newly-diagnosed hypertension patients

Abstract

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73–0.79), CHD (aHR 0.66, 95% CI 0.62–0.69) and stroke (aHR 0.84, 95% CI 0.80–0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.

Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review

“… Same ph. ≥ 5 years HbA1c Blood pressure BMI LDL Choi, Choi et al (2020) [ 29 ] South Korea Retrospective cohort HT: 244,187 ≥ 20 11 CoCI 0.23, 0.36, 0.56 Complication (CVD) II. Service Utilisation Knight, Dowden et al (2009) [ 56 ] Canada Retrospective cohort DM: 1143 ≥ 65 3 CoCI UPCI SECON 0.75 Hospitalisation Hong, Kang et al (2010) [ 10 ] South Korea Retrospective cohort HT: 858,927 DM: 268,220 HT: 71.5 (5.0) DM: 70.6 (4.6) 4 CoCI 0.20 (low/med) 0.40 (med/high) Hospitalisation A&E attendance Lin, Huang et al (2010) [ 37 ] Taiwan Retrospective cohort DM: 6476 58.8 (12.7) 5 UPCI 0.47 (low/med) 0.75 (med/high) Long-term hospitalisation Short-term hospitalisation Liu, Doug et al (2010) [ 57 ] United States Retrospective cohort DM: 3873 58.7 (58.3–59.1) 2 FCI (site) No cut-off A&E attendance <...>…”

“…Details of the definitions and formulae of all continuity of care measurement tools used in the reviewed studies are listed in Additional file 2 . The two most frequently used continuity of care instruments were the continuity of care index (CoCI) (20 studies) [ 7 , 10 , 13 , 18 , 25 , 26 , 29 , 33 , 39 – 41 , 45 , 47 , 53 – 56 , 59 – 61 ] and usual provider continuity index (UPCI) (12 studies) [ 27 , 36 – 38 , 42 , 44 , 45 , 48 , 49 , 52 , 56 , 58 ]. CoCI measures the dispersion of visits of a patient to different providers [ 63 ], which is calculated by , where k is the number of providers, is the number of visits to provider i and N is the total number of visits of the patient.…”

“…None of the studies showed any improvement in lipid profile [ 32 , 34 , 36 , 42 , 46 , 51 ] or BMI [ 31 , 35 , 46 ]. All seven studies that examined the risk of disease-related complications such as cardiovascular disease, end-stage renal disease found that continuity of care reduced complication risks [ 29 , 40 , 47 , 52 – 55 ].…”

Efficacy of Statin Therapy in Patients with Hospital Admission for COVID-19

“…Additionally, a sensitivity analysis of in-hospital statin compliance was performed. Incomplete statin therapy was defined by medication possession ratio (MPR) lower than 0.8 during the hospital stay [25][26][27]. Supplementary analysis was conducted to assess the in-hospital mortality of incomplete statin users compared to statin non-users.…”

How would COVID-19 protocols have impacted on continuity of care of hypertension patients

“…Among the population aged over 20, the estimated hypertension prevalence is 29%, and among the patients diagnosed with hypertension, the controlling rate is only 47% 1 . High blood pressure is the most important modi able risk factor with the most signi cant in uence on cardiovascular or cerebrovascular diseases 2,3 . According to the National Health Insurance Service (NHIS) statistics in Korea, the estimated medical cost of treating hypertension was 3.83 trillion Korean Won (i.e., 3.4 billion U.S. dollars).…”